Provider Demographics
NPI:1972088714
Name:PELLOW, JOE
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:PELLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6904 BRIARCREEK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7214
Mailing Address - Country:US
Mailing Address - Phone:405-209-0227
Mailing Address - Fax:
Practice Address - Street 1:6904 BRIARCREEK DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-7214
Practice Address - Country:US
Practice Address - Phone:405-209-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist